The therapy of iatrogenic lesions of the bile duct

Forty-three patients were operated on for iatrogenic lesions of the bile duct. Only one patient had a biliary lesion which occurred in the course of distal gastric resection. All other lesions were observed during cholecystectomy. Injury of the bile duct was detected intraoperatively in sixteen cases. In 10 patients, lesions were observed in the postoperative period and in 17 patients, the post-operative diagnosis was made on the basis of symptoms of stenosis of the bile duct. Satisfactory results can be obtained by suturing the common bile duct and splinting with a T-tube where the lesion is partial and detected in the course of surgery. In the case of patients with strictures, an anastomosis (choledochojejunostomy Roux-en-Y loop) should be performed. Strictures involving hepatic bifurcation and the right hepatic duct have a higher incidence of restenosis, and transhepatic splinting of the anastomosis can therefore produce better results. Long-term transhepatic drainage has the advantage that replacement of the drain is relatively straightforward and complete dislocation impossible. Four of our patients died postoperatively, three of multiple septic organ failure due to preoperative biliary peritonitis or cholangitis, and one of a pulmonary embolism. Satisfactory long-term results after correction of an iatrogenic lesion of the bile duct can be obtained if the corrective procedure is undertaken immediately, prior to the onset of biliary cirrhosis.